PITTSBURGH – Patients with painful knee osteoarthritis who received electrical stimulation of the periosteum facilitated by acupuncture needles showed modest improvement in pain, according to a study at the Veterans Administration Pittsburgh Healthcare System (VAPHS).
Background in the article, published in the journal Clinical Therapeutics, noted that because of “morbidity associated with painful knee osteoarthritis (OA) and commonly prescribed analgesics, patients often pursue complementary and alternative modalities” such as acupuncture.”
Citing previous studies on the short-term tolerability and efficacy of periosteal stimulation therapy (PST) for older adults with advanced knee OA, researchers said they sought to find out how effective the treatment would be in the longer term.
The study involved 190 participants older than 50 years with Kellgren-Lawrence grade 3 or 4 knee OA and chronic pain. The group was randomized to either PST once a week for 10 weeks followed by PST boosters for six months, once every two weeks twice, then once a month; control PST — i.e., periosteal needles and brief electrical stimulation of control points once a week for 10 weeks; or PST for 10 weeks followed by control PST boosters for six months.
The primary outcome measure was change in the Western Ontario and McMaster Universities Osteoarthritis Index pain score immediately after the 10-week intervention and at six-month follow-up, nine months after baseline. Outcome Measures in Rheumatology Clinical Trials–Osteoarthritis Research Society International (OMERACT_OARSI) criteria also were evaluated.
Secondary measures of outcome included physical performance, psychological factors, health-related quality of life, rescue pain medication use and healthcare utilization.
After adjusting for pain at baseline, researchers found that the PST and control booster did not differ from controls at 10 weeks (difference, 1.3; 95% CI, -0.10 to 2.8; P = 0.0683) or 9 months (difference, 1.1; 95% CI, -0.32 to 2.6; P = 0.13). The PST and PST booster group had similar improvement compared with controls at 10 weeks (baseline adjusted difference, 1.1; 95% CI, -0.34 to 2.5; P = 0.1369) but significantly greater improvement at nine months (baseline adjusted difference, 1.5; 95% CI, 0.069 to 3.0; P = 0.0401). A lower likelihood of response was found in participants with baseline depressive symptoms, low self-efficacy, higher difficulty performing daily activities and greater knee stiffness.
“Should practitioners who care for older adults with painful advanced knee OA and limited therapeutic alternatives recommend PST as a viable treatment option? Our results support the following: (1) PST is well tolerated, (2) the likelihood of an initially significant clinical response appears to be approximately 4 in 10, and (3) the response can be maintained for at least six months with boosters in men with KL grade 3 and grade 4 disease,” the authors recommended. “Additional research that uses other study designs (e.g., comparative effectiveness and adaptive design) is needed, and, perhaps more importantly, thoughtful discussions between patient and physician are necessary so that well-informed and reasonable decisions can be made.”
1 Weiner DK, Moore CG, Morone NE, Lee ES, Kent Kwoh C. Efficacy of periosteal stimulation for chronic pain associated with advanced knee osteoarthritis: a randomized, controlled clinical trial. Clin Ther. 2013 Nov;35(11):1703-20.e5. doi: 10.1016/j.clinthera.2013.09.025. Epub 2013 Nov 1. PubMed PMID: 24184053.
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